Body composition and prognosis in chronic systolic heart failure: the obesity paradox

Lavie, Carl J.; Osman, Ahmed; Milani, Richard V.; Mehra, Mandeep R.

doi:10.1016/s0735-1097(02)80848-8

Cited by 72 publications

(110 citation statements)

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“…We did not account for changes in BMI that could have occurred during the follow‐up period, and may have influenced outcomes. We also did not have data on measured adiposity other than BMI, such measures (fat distribution imaging) may have helped in investigating mechanisms. We also did not have data on the doses of various cardioprotective medications that may have contributed to the observed difference between groups.…”

Section: Discussionmentioning

confidence: 99%

Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Echouffo‐Tcheugui

Bao

Curtis

et al. 2019

European J of Heart Fail

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Aims To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT‐D) implantation. Methods and results Medicare beneficiaries with HF aged ≥ 65 years (n = 18 922) undergoing first‐time CRT‐D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter‐Defibrillator Registry between 2010 and 2013, were followed for 3 years post‐implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device‐related complications by BMI status. Of 18 922 HF patients receiving CRT‐D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5–24.9 kg/m2), underweight patients had a higher 3‐year post‐device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09–1.65); P < 0.001] and of readmission [sub‐aHR: 1.25 (1.09–1.42); P < 0.001]. The corresponding 3‐year aHRs for death were 0.83 (0.77–0.89) for overweight, 0.74 (0.67–0.82) for obesity class I (BMI 30–34.9 kg/m2), 0.78 (0.68–0.90) for obesity class II (BMI 35–39.9 kg/m2), and 0.75 (0.60–0.93) for obesity class III (BMI ≥ 40 kg/m2, P for all categories < 0.001). Individuals with class III obesity had a higher risk of readmission [sub‐aHR: 1.17 (1.06–1.30)]. There were no differences in rates of device‐related complications within 90 days across BMI categories. Conclusion Most elderly patients with HF receiving CRT‐D were overweight or obese. While being underweight was associated with greater risks of death and hospitalization, overweight and obese patients were at lower risk of death after CRT‐D.

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Section: Discussionmentioning

confidence: 99%

Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Echouffo‐Tcheugui

Bao

Curtis

et al. 2019

European J of Heart Fail

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“…15 This undernutrition, which has been variably defined as weight loss over time, low BMI, low percent ideal body weight, or decreased fat mass, has invariably been linked to poor outcomes in HF. 3,15,16,37 However, the interrelationship between cardiac cachexia and albumin levels had not previously been studied. This study demonstrates that hypoalbuminemia is present to a similar degree in lean, overweight, and obese HF patients, and thus suggests that hypoalbuminemia and cachexia in HF may have discrete pathophysiologic mechanisms and that hypoalbuminemia may not only be related to energy intake but also a reflection of inflammation.…”

Section: Discussionmentioning

confidence: 99%

Albumin levels predict survival in patients with systolic heart failure

Horwich¹,

Kalantar-Zadeh²,

MacLellan³

et al. 2008

American Heart Journal

335

229

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“…However, the impact of obesity on outcomes in patients with cardiovascular disease is often complex 3–13. Although obesity is associated with reduced mortality in HF,3–5 in patients with AMI, obesity has been variably described to have a positive, neutral, or negative association with mortality 6–13. These variations have been attributed to methodological differences of these studies and residual bias.…”

Section: Introductionmentioning

confidence: 99%

Association of obesity and survival in systolic heart failure after acute myocardial infarction: potential confounding by age

Pitt

Anker

et al. 2010

European J of Heart Fail

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AimsTo determine the association between obesity and outcomes in post-acute myocardial infarction (AMI) patients with systolic heart failure (HF). Methods and resultsOf the 6632 Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) participants, 6611 had data on baseline body mass index (BMI) and 6561 had BMI ≥ 18.5 kg/m 2 . Of these, 1573 were obese (BMI ≥ 30 kg/m 2 ) and 4988 were non-obese (BMI 18.5-29.9 kg/m 2 ). Propensity scores for obesity, estimated for each patient, were used to assemble a cohort of 1519 pairs of obese and non-obese patients who were balanced on 65 baseline characteristics. All-cause mortality occurred in 13.7 and 13.8% of matched obese and non-obese patients, respectively, during 16 months of median follow-up [matched hazard ratio (HR) for obesity 0.98; 95% confidence interval (CI) 0.79-1.21; P ¼ 0.831]. Before matching, the obese group was younger (mean age, 62 vs. 64 years; P , 0.0001) and had more women (37 vs. 26%; P , 0.0001). The paradoxical pre-match association between obesity and reduced mortality (unadjusted HR 0.82; 95% CI 0.70-0.95; P ¼ 0.008) disappeared when adjusted for age alone (age-adjusted HR 0.91; 95% CI 0.78-1.06; P ¼ 0.206) but not for gender alone (genderadjusted HR 0.79; 95% CI 0.68-0.92; P ¼ 0.003). Obesity had no association with mortality in 1573 pairs of agematched obese and non-obese patients (age-adjusted HR 0.94; 95% CI 0.77-1.13; P ¼ 0.484). ConclusionIn post-AMI patients with systolic HF, obesity provides no independent intrinsic survival benefit. The paradoxical unadjusted survival associated with obesity is largely explained by the younger age of obese patients.--

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Body composition and prognosis in chronic systolic heart failure: the obesity paradox

Cited by 72 publications

References 0 publications

Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Body mass index and outcomes of cardiac resynchronization with implantable cardioverter‐defibrillator therapy in older patients with heart failure

Albumin levels predict survival in patients with systolic heart failure

Association of obesity and survival in systolic heart failure after acute myocardial infarction: potential confounding by age

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